The Relationship Between the CASTLE (EUROCTO) Score and Contrast-Induced Nephropathy in Patients Undergoing Coronary Chronic Total Occlusion Interventions

Background: Contrast-induced nephropathy (CIN) is still recognized as a major complication in patients undergoing chronic total occlusion (CTO) interventions. The predictive value of CTO complexity scores for CIN remains unclear. The present study investigated whether the CASTLE (EuroCTO) score is associated with the development of CIN in patients treated with CTO-PCI.Methods: A total of 356 patients undergoing CTO-PCI were retrospectively analyzed and classified according to CIN development. Clinical, angiographic, and procedural characteristics were compared between groups. Missing data were handled using multiple imputation, and independent predictors of CIN were identified through multivariable logistic regression analysis. The predictive performance of CTO scoring systems was evaluated using receiver operating characteristic (ROC) curve analysis.Results: CIN was observed in 34 patients (9.5%). Individuals who developed CIN were generally older, more frequently diabetic, and had lower left ventricular ejection fraction values. Procedural complexity was greater in the CIN group, reflected by higher CASTLE and J-CTO scores, longer lesion length, and higher contrast volume. In multivariable analysis, the CASTLE score remained associated with CIN (OR: 1.838, 95% CI: 1.354–2.494, p2 providing a reasonable balance between sensitivity (70.6%) and specificity (63.3%).Conclusion: The CASTLE (EuroCTO) score showed an association with CIN occurrence in patients treated with CTO-PCI and demonstrated acceptable predictive capability compared with other CTO scoring models. Although the score may contribute to preprocedural risk assessment, the results should be interpreted carefully.